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Why Do Older Chinese Face Higher Death Rates in Rural Areas?

(February 2008) Death rates for Chinese ages 50 and older are about 30 percent higher in rural areas than urban ones. Why are rural Chinese at such a disadvantage?

According to an article in the Journal of Gerontology, cadre status, which is more common in urban areas, is a powerful determinant of mortality. Chinese adults who are cadres, or public officials who hold responsible or managerial positions in the party and government, had a significantly lower risk of death, according to the article's findings. Cadres typically enjoy access to privileges, beyond what the average citizen might expect. For example, they may have better access to health services, housing, and jobs. Some have argued that cadres have recently become a kind of elite civil servant. Besides being a proxy for socioeconomic factors and access to health services, according to the authors, cadre status may also confer positive psychological effects by lowering levels of stress and increasing feelings of self control and self-worth.

"Researchers have long recognized the link between socioeconomic status and health in many countries," says Toshiko Kaneda, co-author of the study and a policy analyst at the Population Reference Bureau. "The significance of the cadre status effect on mortality highlights how important it is to look at the impact of culturally specific measures of socioeconomic status."

At the community level, the number of amenities within the community and the average wage for an ordinary male worker were important factors behind the urban advantage. Urban communities on average offer higher wages and more amenities than rural ones.

The most important community amenities were, in order, telegraph service, electricity, telephone service, and paved roads. These amenities are important parts of the transportation and communications infrastructures that allow older people to access formal or informal care. Such amenities enhance older adults' ability to travel to health care facilities and stay in touch with their children, both of which contribute to better health and well-being.